Central Intake Hip and Knee

In December of 2017, the Ministry of Health and Long-term Care mandated the creation of Central Intake and Rapid Access Clinic programs. This provincial health-care initiative is designed to improve access to timely, high-quality assessments for patients with moderate to severe hip and/or knee arthritis.

Referrals are sent to the Central Intake site in Kingston, instead of directly to an orthopedic surgeon’s office, using the standardized hip and knee arthritis referral form. Referrals sent directly to an orthopedic surgeon will be redirected back to the referring physician/nurse practitioner with instructions to redirect the referral to Central Intake. Please note that this can result in delays for patient care.

The referring physician, nurse practitioner, and patient have the option of choosing services from a specific hospital, specific surgeon, or next available surgeon. The final decision about who a patient would like to be referred to is up to the patient, who has been informed of all their options by the advanced practice physiotherapist.

 

Referring a Patient

The following information is required for a patient with moderate to severe arthritis who is considering hip or knee replacement surgery for the first time:

  1. Download and complete the standardized hip and knee arthritis referral form.
  2. X-ray report of the affected joint(s) done within the last 6 months. Recommended views:
    1. Hip: AP pelvis (centred at pubis), and Lateral of affected hip(s)
    2. Knee: Bilateral skyline (same film) and standing AP (same film), and standing Lateral (flexed at 30°) of each knee
  3. The patient’s cumulative patient profile (past/current medical/surgical history, current medication and any known allergies)

Please send completed referrals to the Central Intake in one of two ways:

  1. OCEAN e-referral system
  2. Fax: 613 549 8382

If you have questions or would like to provide feedback about this program, please contact John Hope, advanced practice physiotherapist and regional coordinator SE LHIN Hip and Knee Joint CIAC/RAC Program, at @email or 613.544.3400 ext. 3013.

 

Rapid Access Clinics

Once a referral has been reviewed for completeness and triaged according to the information provided, it is sent to the appropriate Rapid Access Clinic (RAC) usually the one closest to the patient’s home address. There are 4 RACs located in the southeast region: Kingston Health Sciences Centre, Quinte Health Care in Belleville, Perth and Smiths Falls District Hospital, and Brockville General Hospital.

At the RAC, patients will be seen by an advanced practice physiotherapist who has been specifically trained by local orthopedic surgeons. A detailed assessment will be completed to confirm if an orthopedic surgeon consult is needed. 

The goal of the RAC is to ensure patients are assessed and diagnosed in a timely manner (within 4 weeks of receipt of referral), and provided with surgical and non-surgical management options.

If patients are deemed to be surgical candidates, they will be provided with appropriate surgeon-specific wait-time information and will have the option of choosing a surgeon based on their specific needs.

Advanced practice physiotherapists at each RAC site have the ability to refer a patient to any orthopedic surgeon within (and outside of) our region.

 

Imaging Guidelines for Hip and Knee Symptoms

Imaging guidelines for knees:

  • All patients who require imaging for chronic knee symptoms should get plain X-rays FIRST (American College of Radiology – Appropriateness criteria evidence based guidelines - 2018)
  • A MRI is NOT necessary if X-rays show any degenerative changes within the joint. NO further imaging is required.
  • If the X-ray report indicates NO evidence of arthritis, then a MRI is warranted to evaluate for a surgical lesion. These cases should be referred directly to a knee sport medicine surgeon and not Central Intake.
  • U/S imaging is NOT useful for a knee joint unless there is suspicion of an extra-articular soft-tissue mass or extensor mechanism disruption.

Imaging guidelines for hips:

  • All patients who require imaging for chronic hip symptoms should get plain X-rays FIRST (American College of Radiology – Appropriateness criteria evidence based guidelines - 2016)
  • A MRI is NOT necessary if X-rays show any degenerative changes within the joint. NO further imaging is required.
  • If there is NO joint degeneration noted on the X-ray, then a MRI is warranted to evaluate for a surgical lesion. These cases should be referred directly to either Dr. G. Wood or Dr. P. Shim (sports medicine hip surgeons) and not to Central Intake.